FDA: Soap and Water Are Best, Hand Sanitizers A Good Alternative (3 Ingredients Need More Study)

Is there anything that says “Mom Purse” quite as convincingly as a convenient, pump-top bottle of hand sanitizer? What could be more common, more convenient, more effective? Grab, gel, and go, right?

Not so fast.

The evidence is clear: If you can find a sink and some soap, you should head there and wash up instead. That’s because hand sanitizers are not as effective at removing germs and other contaminants as actually washing your hands.

When it comes to preventing the spread of respiratory and diarrheal illnesses, the Centers for Disease Control and Prevention is clear: Washing with soap and water is always the number one line of defense. The simple act of wet/lather/scrub/rinse/dry physically removes contaminants including viruses and bacteria, thereby breaking the chain of infection.

But in the real world, millions today rely on alcohol-based hand sanitizers on a daily basis to reduce their chances of getting sick by killing bacteria on their hands—some, like healthcare workers, mothers, schoolchildren, and teachers, many times per day. And it was for reason FDA originally undertook the first systematic review of these products since 1994.

New Rule: 28 Ingredients Out

On April 11, 2019, the United States Food and Drug Administration issued a final rule banning a total of twenty-eight active ingredients previously found in some over-the-counter hand sanitizers due to safety concerns. (Most of these ingredients had already been removed from the market after a preliminary rule was issued in 2016; the new rule will not affect the availability of widely available commercial sanitizers).

The drug safety oversight body also announced it was still studying three active ingredients in hand sanitizers, including benzalkonium chloride, ethyl alcohol, and isopropyl or “rubbing” alcohol—leaving open data-gathering on these substances’ long-term safety.

In a statement accompanying the final rule, the agency said, “The FDA wants to make sure the benefits of hand sanitizers outweigh the risks. For example, in the last few years, we have learned that some active ingredients in these antiseptics can be absorbed through the skin. As people use hand sanitizers more often, we want to make sure that any absorption is minimal and not harmful. We also want to confirm these products work as intended.”

Other Hand Sanitizer Cautions for Frequent Users

FDA continues to emphasize the importance of hand hygiene in the prevention of illness and its spread and emphasizes sanitizers have their place when soap and water aren’t practical and offers the following caveats:

  1. Use sanitizer with at least 60 percent alcohol. Less may irritate skin, cause the development of resistant germs, or fail to work on all classes of germs.
  2. Be aware that hand sanitizers don’t work well on visibly dirty or greasy hands. If you can see what’s contaminating your hands, find a sink and soap, not a bottle.
  3. Accidental or intentional ingestion of hand sanitizer can cause alcohol poisoning. Between 2011 and 2015, a staggering 85,000 children swallowed hand sanitizer; adults have also been known to intentionally drink the substance because of its high concentration of ethyl alcohol. Due to this documented phenomenon, keeping hand sanitizer secure or out of locked restrooms in health care settings where vulnerable people may be tempted to access and abuse it may be a concern worth noting in medical and dental practices that serve vulnerable, young, or recovering people.

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